Death due to Vit D deficiency – Call for updated guidelines

The tragic death of a six-month-old baby in the UK who died following complications of heart failure caused by severe Vitamin D deficiency has raised the voice of the clinicians in India and across the globe. The case appears in the journal BMC Pediatrics. As vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population. so there is a greater chance of occurrence of such incidents in India also. It has now become essential for necessary amendments in the vitamin D supplementation policy to protect the health and lives especially of babies, pregnant women, and dark-skinned individuals

The researchers of the University of Birmingham highlighted the death of a baby and serious ill health of two others due to a vitamin D deficiency. The research of Holger and Uday outlines the cases of three babies aged five to six months, including Noah, all born in England to mothers of Black, Asian and Minority Ethnic (BAME) origin who developed low-calcium heart failure and rickets as a direct consequence of vitamin D deficiency. The researchers also found that five of the nine family members of these three babies also had the bone disease caused by vitamin D deficiency.

The researchers argue that current UK recommendations for infants and children are very complex and outdated. So an updated and simplified guidance is required which will include supplementation of all babies from birth, regardless of whether they are formula or breastfed.

The authors demanded UK government intervention into the matter to introduce mandatory monitoring of babies and pregnant women to ensure they are taking vitamin D supplements.

The authors suggested that studies should explore the feasibility of introducing a rickets prevention programme which would see children receiving oral bolus Vitamin D supplements alongside routine immunizations at GP surgeries, with a similar strategy for pregnant women at antenatal visits.

Vitamin D is essential for skeletal growth and bone health, and deficiency can result in rickets, soft bones, and seizures or heart failure as a result of a lack of calcium. Those, particularly at risk, are the Black, Asian and Minority Ethnic (BAME) groups, which make up at least 14% of the UK population.

Dr. Wolfgang Hogler said,”These three cases have in common that their risk and need for supplementation went unrecognized, adherence to supplementation was not monitored, and that clinical symptoms were relatively silent until severe complications manifested. The extent of disease, only unveiled by X-rays, tests and post-mortem investigations, went unnoticed”.
“The complications in these babies were fully preventable and represent only the tip of the iceberg of widespread deficiency in risk groups. They expose a public health failure to address vitamin D deficiency as an important health problem with potentially devastating consequences,” he added.

Key Recommendations:

The inclusion of regular checks for adherence to vitamin D supplementation in antenatal care and the red book child surveillance program.

Introduce mandatory monitoring of babies and pregnant women to ensure they are taking vitamin D supplements.

Updated and simplified guidance to include supplementation of all babies from birth, regardless of whether they are formula or breastfed.

Educate all pregnant women and new mothers regarding the importance of taking Vitamin D supplements in pregnancy and infancy.

A study exploring the feasibility of introducing an NHS prevention programme which would see children receiving Vitamin D supplement oral bolus doses routinely alongside other routine immunizations at GP surgeries, or during antenatal visits.

New research exploring the true burden of rickets and osteomalacia (the softening of bones) in the UK, and a comparison of different supplementation strategies.

Further studies to bridge the gap in knowledge required to facilitate food fortification with vitamin D, and to compare the cost-effectiveness of fortification versus supplementation programmes.

The government should consider linking financial family support to adherence to all prevention programmes.

Making a group of healthcare professionals responsible for delivering the prevention programme.

Vinay Singh

Vinay Singh joined Medical Dialogue as Desk Editor in 2018. He covers the medical speciality news in different medical categories including Medical guidelines, updates from Medical Journals and Case Reports. He completed his graduation in Biotechnology from AAIDU and did his MBA from IILM Gurgaon. He can be contacted at editorial@medicaldialogues.in . Contact no. 011-43720751

Agreed that their could be severe consequences like death in newborns due to vitamin d deficiency.
While working in Kuwait in the year 1991 to 1995 ,I worked on vitamin d deficiency in newborns and found that FTND newborns with as low as 3 nmol/L.
Since vitamin d directly or indirectly controls more or less all the metabolic activities in the body.It can influence all the vital organs and create morbid and mortal complications.
Indian J Pediatr 1999,66:37-43

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